We have covered the topic of vitamin B12 in detail. Now let’s look at folic acid or vitamin B9, abundant in plant foods, and more particularly in everything that is “green” such as broccoli, parsley, tarragon, avocados and green beans especially. You will find the best food sources of vitamin B9 along with those of numerous other nutrients (vitamins, minerals, trace-elements, anti-oxidants, omega 3 & 6 fatty acids, amino acids…) on my website www.gmouton.com. Click on “Lists”, and then choose “French” and download free of charge the PDF file corresponding to the “List MINU”.

Vitamin B9 gives us with the same information as vitamin B12 as long as we take into account the food intake of the patient. Any patient consuming a lot of green vegetables and showing a low folic acid level must be suspected of intestinal malabsorption. Be careful though: the classic reference range extend too low due to the inclusion of too many people in the reference group that are deficient (elderly patients, not eating enough vegetables or not absorbing them) and therefore one must be wary of any low values in the normal range: as they likely are not!

Any patient who doesn’t supplement with vitamin B9 (present in the multivitamins and vitamin B complex) and whose blood level exceeds the range of normal values must be suspected of bacterial overgrowth in the small intestine (Small Intestinal Bacterial Overgrowth or SIBO). The cause is often the use of antacids or proton pump inhibitors, but we can also find the same problem with those who do not secrete enough hydrochloric acid because of lesions on the wall of the stomach. Atrophy of the acid-secreting cells can develop in some patients or it can be due to an autoimmune attack on these cells.

This is an opportunity to warn you against supplementing with vitamins that are not strictly natural molecules. Do not use cyanocobalamin but the molecules naturally found in the body as methylcobalamin or hydroxocobalamin. Moreover, the natural form of vitamin B9 is not the folic acid omnipresent in dietary supplements but rather the 5-methyltetrahydrofolate form. Unfortunately the natural form of B9 is hardly available in Europe, making it very difficult to find, due to the very restrictive legislation in the European Union …

Iron constitutes the third member of the trio of indispensable anti-anaemic nutrients, but it is the subject of a separate blog as there is such an enormous wealth of material on this particular subject. But here too, beware of chemical forms: for example I detest ferrous sulphate, which results in very frequent intestinal problems (even if some people can tolerate this form strangely well). Its inefficiency imposes the need for supra-physiological doses, which is in contrast to organic forms (I especially prefer glycinate), more bioavailable and thus can be prescribed at much lower dosages.

One must also be aware that – in the absence of a deficiency of one or more of the three anti-anaemic nutrients – the haemoglobin level reflects the overall health of the individual. In particular there is a decrease in haemoglobin in patients with intestinal dysbiosis or alteration of the intestinal ecosystem, so much so that when the haemoglobin level rises this often reflects the positive progress of their intestinal ecosystem, whether it be of the intestinal flora or the gut mucosa.

Finally, I point out the huge impact of thyroid function on our ability to produce haemoglobin. This synthesis occurs in the bone marrow under the influence of erythropoietin (better known as EPO). This hormone can only be produced by the kidneys under the action of the active thyroid hormone T3. Any thyroid disease is typically associated with anaemia – directly through the lack of EPO and also indirectly via the development of iron deficiency, another typical consequence.

Pottery was reputedly invented by hunter-gatherers living in the Far East 20,000 years ago. The earliest ceramics have been attributed to a Japanese tribe called “Jomon” and artefacts dating from 15,000 years ago have been examined by researchers from the Department of Archaeology at the University of York in England. They used a new technology to analyze the food residues associated with these prehistoric potteries. The researchers were particularly interested in lipids that were isolated from the carbon deposits still present on the surface of these very ancient objects.

Guess what they found: traces of freshwater fish and marine fish! Yes, about 200 centuries ago ceramic was created not only to cook with, but also to consume fish, confirming its noble place as the food that has contributed to generate the human species!

What does fish contain that is so extraordinary and is not found in meat? First of all, it is not the high quality protein, iron, zinc, vitamin B12 and coenzyme Q10 that are present as much in meat as they are in fish. You are getting warmer if you guessed iodine, but algae provide much more of that substance, or selenium, but then you should rather opt for Brazil nuts. You are even getting even hotter if you mention vitamin D, but this is not as good a source as sunshine.

However, you hit the jackpot if you name Omega 3 and specifically its long chain fatty acids: EPA (eicosapentaenoic acid) and DHA (docosapentaenoic acid). These are found in fish and a few special algae (although this is rather true for DHA, than for EPA). These two polyunsaturated fatty acids have exceptional qualities…

EPA constitutes the most powerful natural anti-inflammatory available. DHA constitutes the most flexible molecule of the living world with its record number of double bonds (6), all of which provide a point of inflexion. In the human body, all of the most delicate tissues – retina, synapses (connections between neurons) and the mitochondria (where the energy unit or ATP is made) – are all packed full of DHA. Any place where lubrication is needed, DHA should be found.

Strict vegetarians (often for religious reasons, which is difficult to question) and some others (who I do not agree with) will state that we humans do have the enzymatic facilities necessary to convert alpha-linolenic acid into EPA and then into DHA, through a series of enzymes called desaturase and elongase.

While true to a degree, there are big obstacles to surpass for this to happen! The first one consists of obtaining the famous alpha-linolenic acid, referred to as "essential" because we cannot synthesize it. It must therefore come from the diet (flaxseed oil, hemp oil, a little in canola oil and walnut oil) or from supplementation (perilla oil, camelina oil). Once we have got past that hurdle then we must convert this fatty acid, which is the foundation of the omega 3 family, into more unsaturated and longer fatty acids. It is the first step however that is a very difficult problem to overcome.

This first step is governed by the enzyme delta-6-desaturase, which is a real troublemaker and can be easily blocked in cases of stress and is dependent on adequate supplies of zinc, magnesium and vitamin B6 (the first two actually consumed by stress). Furthermore this enzyme does not function well in children, older people, pregnant women, smokers, alcohol drinkers, diabetics, the obese, and in bulimics and anorexics…

For readers that are passionate about this topic you will find more detailed information and very precise diagrams in all my conferences on fatty acids, on my website www.gmouton.com (click on the tab “Conferences” and “Unsaturated Fatty Acids”).

We pick things up where we left off, with the proven fact that the valuable long-chain fatty acids EPA and DHA, the jewels of the omega-3 family, are poorly converted from omega-3-rich vegetable oils because of the many obstacles blocking the metabolic pathway. As such, we are back to our fundamental principles: consume fish (if possible fatty) or otherwise consider supplements containing EPA and/or DHA.

For the sceptics, I would like to remind them that the founding theory of humanity, the one that is now most in vogue, is that some apes gradually evolved as humans because they started to consume fish from the lakes in the East-African Rift. This enormous valley of 6000kms long and 50kms wide is now considered to constitute the cradle of humanity, whether it is the ancestor Lucy discovered in Ethiopia or the amazing fossils found on the shores of Lake Turkana in Kenya. It is thanks to the omega 3 fatty acids from fish that the human brain has developed considerably more than that of apes, the latter having developed in a significantly different way.

I would concede that this is a theory that still needs to be proven! But so too the exaggerated claims that “fish is heavily contaminated by heavy metals and other pollutants and should therefore never be consumed”! It is true that some larger carnivorous fish, such as shark, swordfish, and some tuna are contaminated because they are at the top of the food chain, thus containing higher concentrations of mercury for example…but who really wants to eat shark anyway?

Having said that, I do not see the issue with small fatty fish such as sardines, herrings, anchovies and mackerel (not the “king mackerel” of the Gulf of Mexico that inhabit highly polluted waters and have thus become the source of an American obsession towards heavy metals in their fish). I am sorry, but whatever people say, I can’t find any reliable figures that can prove toxic concentrations of heavy metals or PCB’s. Everyone is talking about the contamination but nobody is actually supplying the evidence. Furthermore, we are talking about wild fish that totally escape the abomination that is intensively famed fish.

This reminds me of the mad cow scandal when animal carcasses were used to feed innocent herbivores! It is wrong to say that farm fished do not contain Omega 3 because they do not move much and therefore they accumulate fat. But the nature of this fat obviously depends on what they are eating and here we can encounter many problems resulting from the feed they receive and especially antibiotics used to fight infections that are so common in these concentration camp environments. We are even hearing about GMO fish, in particular of “Frankenstein” salmon, growing as fast as a helium balloon; it's very sad.

Just as we say do not throw the baby out with the bath water; I persist in recommending small wild fish as mentioned above, despite the torrent of criticism towards fish in general. You can also consume sardines, herrings, anchovies and mackerel in tins, which doesn’t alter the quality of the omega 3 fatty acids nor their content. I also question; what role is the meat lobby playing in this controversy?

Why attack fish when “everything” we eat is contaminated?? Terrestrial animals do not escape the effects of pollution and don’t plants constitute the primary target for GMO?? I am somewhat perturbed that our wild little sardines do not receive an “organic’ label while at the same time bringing us the best nutrients at a low cost.

To close the discussion regarding fish I must share a concern, which is the need for the principle of sustainable fishing (as long as it is properly applied). For beautiful illustrations of fatty fish, I recommend that you look at the conference on “Fatty Acids”: see “Conferences/Polyunsaturated Fatty Acids”, section 9b on my website www.gmouton.com.

Due to studies being too short and biased, cholesterol has received a bad press for some 50 years. It is in the interests of the pharmaceutical industry to keep a close watch on this due to its gigantic lobby for statins. This hysterical hatred of "fat” is aided by the modern media network, which causes people to believe that we become fat because we eat fat…

This scientifically absurd claim has brought about many bad remedies, in particular the devastating development of “light” products that simply replace fats by sugars, the only way to preserve the taste of the products in question. As a result, many people fall into the trap of this callous marketing leading to the consumption of overly sweeten products that are much more harmful for health than the foods they replaced, because they wrongly labelled as being too fatty.

This abominable transgression, a real scourge of modern eating habits, explains why I see a majority of patients trying to lose weight who suffer from profound deficiencies in unsaturated fatty acids that are essential to the absorptive quality of the intestinal mucosa. Obsessed by the supposed peril of fat these patients typically lack everything: omega 9 (olive oil and avocado oil), omega 6 (hemp oil and rapeseed oil), and omega 3 (flax oil and again hemp oil). As a result, these unfortunate people are alas desperately dry!

The worst of it is that I often meet with great resistance to the consumption of these vegetable oils because people believe they are going to get fat… this is a tragic error! To bring them around I explain that we are not talking of adding petrol (for their tank) that could make them heavier, but lubricating engine oil. If the engine does not lack oil, it is going to run smoother and burn fuel more efficiently therefore burning more calories. These oils will actually assist these people to lose weight if they are lacking them; such is the importance of lubrication!

Ideally the patient should have a blood test to determine their specific profile of fatty acids, a sure-fire way to personalise the dietary and micronutrient treatment. If you cannot afford it, or want to act quickly, you must first try to balance the three families: omega 3, 6 & 9 as all play essential roles. It is also important not to forget the saturated fatty acids and cholesterol (but not in excess) that have an integral role to play too.

To achieve this, I recommend a mix of two oils with exceptional virtues that are very important for our health: olive oil (omega 9) and hemp oil (omega 6 and omega 3). As for omega 6 and omega 3 only hemp oil supplies a harmonious ratio compatible to human needs, namely three times more omega 6 than omega 3. Keep in mind that flaxseed oil contains too much omega 3 compared to omega 6 for the long term, and rapeseed oil doesn’t contain enough.

Do not be afraid about the use of hemp oil due to its relationship to cannabis, because it is derived from varieties of the plant that do not contain microscopic amounts of THC. It is the THC that is responsible for the psychotropic effects of cannabis. Remember hemp oil is never to be used for cooking! Once the bottle is opened it must be kept in the fridge. It is then consumed raw, which doesn’t necessarily mean cold. Hemp oil can be added to soup, but after cooking, or poured over hot vegetables. There are really so many reasons to consume at least one or two daily tablespoons of hemp oil.

This cocktail of oils will make the intestinal mucosa very happy, with the lubrication allowing for improved absorption of nutrients. “You are what you eat” is a popular saying: and I agree, as long as we can absorb what we eat correctly! Remember that the dryness of the digestive mucosa leads to dramatic consequences for the whole body: poor absorption and weakening of intestinal barrier function.

The intestinal mucosa is, in my opinion, the key to stay healthy. By far the largest surface of our body (600m2 against 2m2 for our skin) it represents the most vital interface between our environment and us. Its integrity dictates our ability to absorb nutrients from our diet – absorptive function – and the protection of the immune system against external aggressors – barrier function.

Loss of barrier function leads to the phenomenon known as “leaky gut syndrome” or intestinal hyper-permeability. This notion has been highlighted for a long while by the Functional Medicine approach and received acclaim in 2005 thanks to the excellent work of Alessio Fasano, professor at the Faculty of Medicine at the University of Maryland. Professor Fasano is a world-renowned expert for having discovered zonulin (the human protein regulating intestinal permeability) in 2001, and the author of masterful articles on celiac disease.

Excessive permeability of the intestinal mucosa causes an invasion of aggressors to the immune system: non-digested food molecules, toxins of all sorts, and even whole microorganisms. The flood of antigens over stimulates the immune defences and can often lead to their excessive response (respiratory allergies and food allergies), and can often result in auto-immune diseases where the immune system attacks its own organs and tissues. When we encounter these pathologies, very common today, the optimization of the intestinal mucosa represents the preventive and curative action of choice.

To illustrate the problem of the dryness of the mucosa, which allows entry of aggressors and the subsequent immune system dysfunctions that arise, I often evoke a similar mechanism to the skin. Everyone knows that very dry skin will result in cracks, for example in the fingers or heels. Think of this comparison symbolizing the intestinal mucosa that is dry and cracked, causing obvious permeability. To avoid such a condition, it is essential to lubricate the whole mucosal system.

In fact, if we want to combat an overly dry and damaged skin, we must also target the intestine. We will get much better results by consuming the good oils in sufficient quantities to correct any deficiencies in omega 3, 6 and 9, rather than spreading various moisturisers on the skin that are loaded with chemicals!

This I term the doughnut principle (the one with a hole in the middle) - but a very special donut where the surface of the hole in the centre (symbolizing the digestive tract) is actually three hundred times that of the outer surface of the donut (symbolizing the skin). It goes without saying that any attempt to correct dry or irritated skin would be doomed to fail if we did not give priority to intestinal lubrication via oral intake of necessary nutrients or nutritional supplements when it matters most to rapidly address a major deficiency.

The intestinal mucosa also plays an important role in the problems arising from other mucous membranes, all infinitely smaller and highly dependent on the “great mucosa”. We list in no special order respiratory, urinary, vaginal, and sinus conditions… without forgetting dryness of the ocular conjunctiva or of the ear canals. As we can see, this domain of intervention appears immense but largely undervalued. This is due to the classification of the patient's problems according to specific medical specialties.

The arbitrary separation of the study of different organs according to anatomical logic ignores a far more important reality to fight against the disease: functional logic that regards all mucosal tissues working in harmony under the direction of the intestinal mucosa as the concert master of the immune system.